The Troublesome Threesome Re-Visited

#60 Be Aware

I have previously discussed the effects of hospital stays, anesthesia, and medications on older adults. Still, I feel compelled to revisit the topic once more after reading a comment by Dr. William H. Bestermann, Jr. Md., author of the Slow Aging and Delay Chronic Disease Development newsletter. He said

Over 50% of patients have memory impairment after elective bypass surgery. “Results showed that 53 percent of patients experienced significant cognitive declines shortly after surgery. Six weeks later, 36 percent were impaired, and after six months, 24 percent. Five years after surgery, however, the incidence of cognitive decline had risen again, to 42 percent.”

His comment reminded me of the hospital stay that changed my life forever.

At age 80, my husband was tooling along. He had some memory loss, but exercised, didn’t drink or smoke, took no prescription drugs, ate somewhat nutritiously, took little trips, and had a full-time job as a website administrator. Then, he had emergency surgery which included a hospital stay, anesthesia, and a two-page list of medications. He was disoriented, aggressive, cantankerous, and scared during that time. He didn’t know where he was, where he lived, or how to get home.

When I brought him home from the hospital, I thought, “OK, we’ve lost ground, and it may take time, but we’re back on track.” I couldn’t have been more wrong!

Doctors would say that surgery saved his life, but the surgery also forever altered his life.

His body healed, but not his memory. I will never know whether it was the hospital stay, the anesthesia, the medication, or a combination of the three, but he changed during those ten days. The person that went to the emergency room was not the person who came home.

He was easily confused, made erratic decisions, was afraid to go out independently, and lost his beloved job. Even so, we managed for a couple of years. We got together with family, took him places, and kept him busy. Then the pandemic arrived: family members couldn’t visit, he couldn’t get out, and his condition declined rapidly. Within six months, he was diagnosed with dementia, and while in a memory care facility, he contacted COVID and died.

To better understand what was happening, I read a lot. Here is a sample of what I learned:

Hospital Stays

According to a PBS article,

Research shows that many older people deteriorate mentally or physically while in the hospital, even if they recover from the initial problem. About one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived.

The older you are, the worse the hospital is for you,” said Ken Covinsky, a physician and researcher at the University of California, San Francisco division of geriatrics. A lot of the stuff we do in medicine does more harm than good. And sometimes, with the care of older people, less is more.

Hospitalization and bed rest can lead to enforced immobilization, reduction of plasma volume, accelerated bone loss, increased closing volume, and sensory deprivation. Those factors can cause vulnerable older persons to fall into an irreversible functional decline. The Annals of Internal Medicine refer to it as The Hazards of Hospitalization.

Anesthesia

Two articles caught my eye regarding the possible side effects of anesthesia.

An aging brain is more vulnerable to the medication that prevents a person from feeling pain during surgery. Anesthesia-related surgery risks more common in older people are:

• Postoperative delirium is a temporary condition that causes patients to be confused, disoriented, unaware of their surroundings and experiencing problems with memory and attention. These symptoms may not start until a few days after surgery, can come and go, and usually disappear after about a week.

• Postoperative cognitive dysfunction (POCD) is a more severe condition that can lead to long-term memory loss - making it difficult to learn, concentrate, and think. Certain conditions such as heart disease, lung disease, Alzheimer’s disease, Parkinson’s disease, or a prior stroke may increase the risk of POCD.

Dr. Damon Raskin, a board-certified internist and medical director in Santa Monica, CA, says that general anesthesia carries a higher risk for the elderly population. According to Dr. Raskin, it takes longer for an older person’s body to rid itself of the chemicals involved in anesthesia, prolonging the harmful effects.

Because of this, many seniors report feeling foggy, slow, and confused for days, weeks, or even months after a surgical procedure. When it comes to seniors with cognitive conditions like Alzheimer’s disease and other types of dementia, it can be difficult for doctors and family caregivers to weigh possible surgery benefits and drawbacks. Anecdotes often point to a direct connection between anesthesia and dementia, but this cause-and-effect relationship is complex.

Medications

The hallmark of dementia is a loss of memory and other cognitive abilities. People with the condition can also experience depression, delusions, agitation, and other symptoms. These mental states can cause distress both to the people with dementia and their loved ones and caretakers.

Medical professionals often prescribe Drugs that treat these symptoms for people with dementia. However, few studies have shown a substantial benefit in this population. And these drugs all have effects on the brain and nervous system. The use of several such drugs simultaneously increases the risk of dangerous side effects such as an increased risk of falls, heart problems, and even death.

The DailyCaring.com website lists six common medication problems in seniors and six ways to solve them. Take a look!

Lessons Learned

There are defintely times when surgery, anesthesia, and medications are the right answer. However, before making that critical decision, I want to be more aware and informed.

• Know about the prescribed drugs or medications and the potential effects of anesthesia.

• Question the length of a hospital stay.

• Get a second opinion when possible.

• Have the appropriate paperwork in order: wills, health and financial power of attorneys, and health care directives.

• Provide the doctor or hospital with a history, a list of current medications, and critical factors such as a failing memory or depression.

• Be a firm advocate

  • I wanted to take my husband home from the hospital before the surgery to get a second opinion. However, doctors talked me into leaving him there – maybe they were right – I will never know.

  • He insisted on going to the emergency room. Would he have been better off, if I insisted he go to the doctor first?

  • Question the need for surgery and the medications. I was concerned about the number of drugs in my husband’s system – but reasoned, “well, they’re the professionals. I better leave it to them.” Maybe not.

  • Say no. When I had cataract surgery, the surgeon planned to give me anesthesia. I asked the anesthetist if it were necessary, and she said no, but people were often afraid to have work done on their eyes. I said let’s try without – that was the right choice.

  • Know more about possible consequences before making decisions. Ask myself do the risks outweigh the benefits of this procedure or medication?

In retrospect, I would provide more information, be more informed, ask more questions, be more forceful, and listen to my intuition. Maybe things would have been different.